CPT code 19316 is for the surgical procedure involving the suspension or lifting of the breast.
CPT code 19316 is used for the surgical procedure known as the suspension of the breast. This procedure involves lifting and securing the breast tissue to correct sagging or drooping, often for cosmetic or reconstructive purposes. It is commonly performed to improve the breast's appearance and symmetry, particularly after significant weight loss, pregnancy, or aging.
When using CPT code 19316 for the suspension of the breast, several modifiers may be applicable depending on the specific circumstances of the procedure. Below is a list of potential modifiers and the reasons for their use:
1. Modifier 50 - Bilateral Procedure
- Used when the procedure is performed on both breasts during the same operative session.
2. Modifier 51 - Multiple Procedures
- Applied when multiple procedures are performed during the same surgical session.
3. Modifier 59 - Distinct Procedural Service
- Indicates that the procedure is distinct or independent from other services performed on the same day.
4. Modifier 76 - Repeat Procedure by Same Physician
- Used if the same procedure is repeated by the same physician on the same day.
5. Modifier 77 - Repeat Procedure by Another Physician
- Applied when the same procedure is repeated by a different physician on the same day.
6. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period
- Used when the patient returns to the operating room for a related procedure during the postoperative period.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Indicates that the procedure is unrelated to the original procedure and is performed during the postoperative period.
8. Modifier LT - Left Side
- Used to specify that the procedure was performed on the left breast.
9. Modifier RT - Right Side
- Used to specify that the procedure was performed on the right breast.
10. Modifier 22 - Increased Procedural Services
- Applied when the work required to perform the procedure is substantially greater than typically required.
11. Modifier 23 - Unusual Anesthesia
- Used when a procedure that usually requires either no anesthesia or local anesthesia must be performed under general anesthesia due to unusual circumstances.
These modifiers help provide additional information about the procedure and ensure accurate billing and reimbursement. Always verify with current coding guidelines and payer-specific requirements.
Determining whether CPT code 19316 (Suspension of breast) is reimbursed by Medicare involves consulting the Medicare Physician Fee Schedule (MPFS) and the guidelines set forth by the Medicare Administrative Contractor (MAC) for your specific region. The MPFS provides a comprehensive list of services covered by Medicare and their corresponding reimbursement rates.
To verify if CPT code 19316 is reimbursed, you would need to:
1. Check the MPFS: Access the MPFS database, which is available on the Centers for Medicare & Medicaid Services (CMS) website. Enter the CPT code 19316 to see if it is listed and to review the associated reimbursement rate.
2. Consult Your MAC: Each MAC may have specific guidelines and coverage determinations that can affect whether a particular CPT code is reimbursed. It's essential to review the Local Coverage Determinations (LCDs) and National Coverage Determinations (NCDs) provided by your MAC to ensure compliance with regional policies.
By following these steps, you can determine if CPT code 19316 is reimbursed by Medicare and understand any specific conditions or documentation requirements that may apply.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and pinpoint underpayments down to the CPT code level, including specific codes like 19316. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements from every payer.
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